| NPI | 1760128581 |
|---|---|
| Former Name | KELLY ANNE HENNIGAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 344950) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 688884) |
| Enumeration Date | 2022-05-05 |
| Last Update Date | 2024-08-22 |